GPs and Purchasing in the NHS: The Internal Market and Beyond by Bernard Dowling

Author:Bernard Dowling [Dowling, Bernard]
Language: eng
Format: epub
Tags: Business & Economics, General, Social Science, Social Work
ISBN: 9781351794039
Google: ie5HDwAAQBAJ
Publisher: Routledge
Published: 2017-11-22T05:35:58+00:00

Yet the negative outcomes of the budget setting methodology were far more serious for fund-holders local to the Crawley Horsham and Royal West Sussex providers. At the former, practices lost a significant amount of money through having their budgets set in accordance with activity in the first half of the year, a circumstance that had quite severe consequences for those joining the scheme in April 1994. At the Royal West Sussex, practices entering the scheme that same year, its fourth wave, actually did quite well out of the methodology, with most of their activity during 1993/94 felling in the data collection period. However, this effect was reversed in the years either side of 1993/94, with the practices in their preparatory year during 1994/95 losing out particularly badly.

These findings comply with answers given during interviews with the chief executives of both the providers and health authority, plus the public health director of the latter. The health authority commonly raised its financial commitment to hospitals in the second half of a financial year. Whilst the huge majority of this money commissioned more elective surgery, three of the provider chief executives maintained that modest numbers of extra outpatient consultations had occasionally been purchased later in the year. This could suggest that some fund-holders may have been budgeted for outpatient services on the basis of the six months during their preparatory year in which least activity was provided to their patients, albeit to a lesser extent than was the case with elective surgery.

In sum, as far as elective surgery at local providers is concerned, West Sussex fund-holders were generally disadvantaged by the use of their historic activity over a six month period in the year prior to them joining the scheme, rather than gaining from this methodology. The aggregate under funding of such practices from waves three to five for surgical activity at four providers, using the techniques for measuring this as detailed in the earlier description of table 5.2, totalled £220,939.

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